5 Steps to Becoming a Skilled Vestibular Clinician

Are you looking to provide best practice care for patients with vertigo, dizziness, or imbalance? Vestibular assessment and/or care is currently being provided by clinicians in the following licensed professions:

  • Physicians
  • Audiologists
  • Physical and Occupational Therapists
  • Physical and Occupational Therapist Assistants
  • Chiropractors/Functional Neurologists
  • Physician Assistants, Nurse Practitioners, and RNs

How you go about becoming a vestibular specialist will depend on your previous training, patient population, and scope of practice for your specific degree and practice.

Here are 5 steps that can guide your progress from novice to expert status!

1. Establish Current Experience Level

To get where you are going, you need to know where you stand today. If you can answer yes to any of the following in a single group, then you likely qualify for that group:

Basic

  • I did not get any vestibular training in school
  • I have attended less than 12 hours (including labs) of vestibular education
  • It has been more than 3 years since I had a semester or weekend basic vestibular course AND since then I have had limited experience caring for patients with vestibular issues
  • I have attended more than one vestibular course, but I have very limited or no experience working with vestibular patients

Intermediate

  • I had a full semester or more in school focused solely on vestibular topics within the past 3 years and have been caring for vestibular patients regularly
  • I have taken at least one basic weekend or week-long vestibular course and see at least 2 vestibular patients a week on average

Advanced

  • I have taken at least four continuing education vestibular courses that covered a variety of patient populations (basic, concussion, cervicogenic dizziness, etc.) AND I have worked with vestibular patients regularly for at least 5 years
  • I have passed both the Duke University competency based course and the Duke competency based renewal course

2. Take Vestibular Courses

Anatomy, exam techniques, and treatment options are the solid foundations of knowledge that you’ll want to master. The anatomy is particularly important and should be thoroughly covered in your first course. Does your course of interest measure up? Based the International Guidelines for Education in Vestibular Rehabilitation Therapy, an intro course should cover evidence-based information about:

  • Basic Science – Inner ear anatomy, physiology, sensory systems and integration, vestibular neural pathways (peripheral to central), etc.
  • Clinical Science – Etiology, pathophysiology, epidemiology, prognosis, and potential medical or clinical interventions for vestibular conditions, differential diagnosis, cognitive/psychological comorbidities, etc.
  • Specific Assessment Skills – Oculomotor exam, positional testing for BPPV, balance testing, subjective visual vertical, scales and self-assessments for patients to rate symptoms and functional issues, dynamic visual acuity testing, etc.
  • Specific Treatment Skills – BPPV maneuvers, gaze stabilization and substitution exercises, habituation, balance and gait training, patient education on footwear, eye care, and environmental adaptations for safety, and appropriate frequency, duration, and individualization of plan of care and home exercise programs, etc.

Note: There is no such thing as an official Vestibular Certification for physical therapists, although individual courses can “certify” you on their personal techniques. As the APTA’s Academy of Neurologic Physical Therapy states, “Currently the APTA does not offer a certification process for physical therapists in Vestibular Rehabilitation.

As a resource, a list of course providers and conferences that cover basic, intermediate, and advanced level vestibular topics has been compiled to support your educational planning. It is highly recommended to take an in-person course for your first course to ensure you receive direct feedback regarding hands-on examination skills.

The course providers listed below are consistently rated as strong courses for physical therapists, but of course you can always read reviews and ask other trusted vestibular clinicians in your field about their recommendations as well:

  • APTA
  • Duke
  • Education Resources Inc.,
  • Emory University
  • Healthclick
  • International Vestibular Conference
  • Skillworks
  • Vestibular Seminars

Vestibular Course Providers

OrganizationCourse TopicsFormatLevelPTPTAOTOTAMD/DOAuDDCPA/NP
360 Neuro HealthRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxxx
American Academy of Audiology HealthcareConferenceBasic; Intermediatex
American Academy of OtolaryngologyHealthcareConferenceIntermediate; Advancedx
APTA - Academy of Neurologic Physical TherapyRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxx
APTA - Combined Sections MeetingRehabilitation; Concussion; PediatricIn-Person CoursesIntermediate; Advancedx
APTA - University of PittsburghRehabilitationIn-Person CoursesIntermediate; Advancedxxxxx
Association of Migraine DisordersHealthcareConferenceIntermediate; Advancedxx
Audiology OnlineHealthcareOnline CoursesBasic; Intermediate; Advancedx
Carrick InstituteChiropractic CareIn-Person CoursesBasic; Intermediate; Advancedxxx
Combined Otolaryngolgy Spring MeetingsHealthcareIn-Person CoursesIntermediatex
Dizziness and Balance Rehabilitation Clinic in CanadaRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxx x x
Duke Competency Based Renewal CourseRehabilitationIn-Person CoursesAdvancedx
Education Resources, Inc.Rehabilitation; Concussion; Cervicogenic Dizziness; PediatricIn-Person Courses; Online CoursesBasic; Intermediate; Advancedxxxxx
Elite Rehabilitation SolutionsRehabilitation; Concussion In-Person Courses; Online CoursesBasic; Intermediatex
Emory University Competency Based CourseRehabilitationIn-Person CoursesIntermediate; Advancedxxx
Functional Neurology SeminarsChiropractic CareOnline CoursesIntermediate; Advancedx
Great Lakes SeminarsRehabilitationIn-Person CoursesBasicx
HealthclickRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; Intermediate; Advancedxxxx
Integrative Clinical ConceptsRehabilitation; ConcussionIn-Person CoursesIntermediate; Advancedxx
International Association of Functional Neurology and RehabilitationChiropractic CareConferenceBasic; Intermediate; Advancedx
International Symposium on Clinical NeuroscienceChiropractic CareConferenceIntermediate; Advancedx
International Vestibular ConferenceHealthcare; RehabilitationConferenceIntermediate; Advancedx
Johns Hopkins MedicineHealthcareIn-Person CoursesAdvancedx
MedbridgeRehabilitationOnline CoursesBasic; Intermediatexxxx
Motivations, Inc.Rehabilitation; PediatricIn-Person CoursesBasic; Intermediatexxx
Myopain SeminarsChiropractic CareIn-Person CoursesBasicx
OTcourses.comRehabilitationOnline CoursesBasic; Intermediate; Advancedxx
PESI Rehab/Vyne EducationRehabilitationIn-Person CoursesBasic; Intermediatexxxxxx
Posture and Balance ConceptsRehabilitationIn-Person CoursesBasic; Intermediatexxxx
Shirley Ryan Ability Lab AcademyRehabilitationIn-Person CoursesBasic; Intermediatexxxx
Skill WorksRehabilitation; Cervicogenic DizzinessIn-Person CoursesBasic; Intermediatex
Specialty TherapyRehabilitation; PediatricIn-Person CoursesBasic; Intermediate; Advancedxxxx
St. Joseph's/Candlar Center for Oto-Neurology HealthcareIn-Person CoursesIntermediatexx
Summit Professional EducationRehabilitationOnline CoursesBasicxxxx
Therapy Network SeminarsRehabilitationIn-Person CoursesBasic; Intermediatexxxx
University of ManchesterHealthcareOnline CoursesIntermediate; Advancedx
Vestibular Schwannoma ConferenceHealthcareConferenceIntermediate; Advancedx
Vestibular SeminarsRehabilitationIn-Person CoursesBasic; Intermediatexxxxx

3. Find a mentor or “Board of Directors”

In order to get guidance as you examine and treat patients with dizziness, you will want to find an experienced clinician to mentor you, likely from your same discipline if available. You can have 3-5 mentors, also known as your “board of directors,” who you can email, call, or video chat with questions that arise as you see more patients with dizziness and imbalance. If mentors are not available within your organization, useful ways to find them can include:

  • Local vestibular clinicians in the Vestibular Disorders Association
  • Contact the largest hospital networks in your area that have vestibular therapists or a balance center to ask about potential mentorship or vestibular education groups for clinicians in the region
  • Vestibular course instructors and lab assistants
  • Specialty section websites
  • Discipline-specific mentorship programs such as the Clinical Mentorship Program through the Academy of Neurologic Physical Therapy

4. Get experience examining patients with the proper tools

Once you’ve gained knowledge by taking coursework, it is essential to get experience working with vestibular patients. A critical part of a vestibular exam is watching eye movements during the oculomotor and positional testing portions. Some of these tests should be done with visual fixation removed (in the dark) to maximize the likelihood of visualizing and recording any abnormal eye movements. Baba et al. (2004) found that if you are using traditional thickened lens Frenzels instead of infrared video goggles (video Frenzels) to view eye movements in the dark, you can miss 66% or more of abnormal eye movements in patients with vestibular pathology. Other important tools can include a tape measure or accommodation ruler to measure convergence, an eye chart for measuring dynamic visual acuity, and an eye occluder for testing for skew deviations. For a helpful list of tools, check out our Essential Equipment for a Vestibular Rehabilitation Clinic.

5. Keep connected for advanced skills and knowledge building

Choose as many resources below as you can to keep your vestibular care fresh, current, and evidence-based and to maximize your connections with leaders in the field:

The field of vestibular care is fascinating in its complexity, rewarding in its ability to literally change the lives of clients who receive quality care, and challenging in its constant evolution of new techniques for evidence based examination and treatment. Should you choose to move forward on your journey to become an experienced vestibular clinician, we applaud and welcome you to this grand adventure. Gaining these skills requires dedication and time, but when done well, it is completely worth the effort!

Questions? Have more tips to recommend? Contact helena@vestibularfirst.com!